Quality improvement - other support


Clinical audit 

Guidelines and Audit Implementation Network (GAIN)
GAIN was formed in Northern Ireland by the amalgamation of the Clinical Resource Efficiency Support Team (CREST) with the Regional Multiprofessional Audit Group (RMAG) and the Northern Ireland Audit Advisory Committee (NIRAAC) to form a single clinical and social care regional audit and guidelines body for Northern Ireland. GAIN is responsible for commissioning regional audits and disseminating audit results. The website provides some guidance on clinical audits including planning an audit and writing an audit report.

Health and Social Care Information Centre: clinical audits
The Health and Social Care Information Centre is commissioned to run audits by a number of organisations including the Healthcare Quality Improvement Partnership, British Heart Foundation and Royal College of Surgeons. The unit works collaboratively with clinical specialists to develop standard audit information systems and functionality for data collection, validation, analysis, reporting and dissemination in both primary and secondary care.

Healthcare Quality Improvement Partnership (HQIP)
The Healthcare Quality Improvement Partnership (HQIP), a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices, was established in April 2008 to promote quality in healthcare, and in particular to increase the impact clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The programme comprises more than 20 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions.

National Advisory Group on Clinical Audit and Enquiries (NAGCAE)
NHS England has an advisory group, the National Advisory Group on Clinical Audit and Enquiries. It aims to provide policy and strategic advice to NHS England on clinical audit, national confidential enquiries and other issues as requested, and support the reinvigoration of clinical audit, both nationally and locally, so as to stimulate improvements in clinical practice and service delivery.

Scottish Intercollegiate Guidelines Network (Sign): Sign audit tools
Sign has launched a series of audit tools to support the implementation of their guidelines. The tools, which have been tested by volunteer groups of doctors and dentists, define current evidence-based practice against which local services may be measured.

National guideline development

Guidelines and Audit Implementation Network (GAIN) (Northern Ireland)
GAIN has a responsibility for the commissioning of regional audit and a programme of regional guidelines development across the health and social care services in Northern Ireland. It also has a role in promoting good practice through the dissemination of audit results and the implementation of regional guidelines. The work of the Clinical Resource Efficiency Support Team in clinical guideline development has been integrated into GAIN.

National Institute for Health and Care Excellence (NICE)  (England and Wales)
The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing guidance and setting quality standards in England and Wales, and managing a national database to improve people's health and social care, and prevent and treat ill health. In April 2013 NICE’s name changed to reflect its new role in social care. This includes the establishment of the NICE Collaborating Centre for Social Care which is a consortium led by and located at SCIE. NICE develops clinical practice guidelines and guidance in health technology guidance which involves appraisals of medicines and treatments and guidance on interventional procedures, public health guidance for the promotion of health and prevention of ill-health, and as from April 2013, social care guidance.

In addition NICE is developing and defining the standards of health and social care that people can expect to receive. These standards "act as markers of high-quality, cost-effective patient care, covering the treatment and prevention of different diseases and conditions." For further information see NICE quality standards.

NICE has also published guidance which aims to help and support health and social care provider organisations to implement NICE guidance and use NICE quality standards to achieve improved quality of care in their local settings. The guide suggests what an organisation can put in place, and what staff can do to use NICE evidence-based guidance and quality standards to improve practice. See: Using NICE guidance and quality standards to improve practice.

NICE is also responsible for the Quality and outcomes framework (QOF) – quality indicators used in general practice as part of a voluntary incentive scheme for GP practices in the UK – see further information About the Quality and Outcomes Framework.

Scottish Intercollegiate Guideline Network (Sign) (Scotland)
The Scottish Intercollegiate Guidelines Network (Sign) develops clinical practice guidelines for the NHS in Scotland. The guidelines are derived from a systematic review of the scientific literature and are designed to act as a vehicle to improve patient-important outcomes and reduce variations in practice. Sign is part of Healthcare Improvement Scotland the organisation which has the key responsibility of helping NHS Scotland and independent health care providers deliver high quality, evidence-based, safe, effective and person-centred care.

National knowledge services

Health on the Net Northern Ireland (HONNI)
Health on the Net Northern Ireland (HONNI) is a gateway to health information provided by the medical library at Queen's University, Belfast. The website provides access to online databases, electronic journals, health care subject gateways and search engines, organisations and associations, general search engines, resource guides and tutorials. An Athens username and password is required in order to access most of these resources from any location. Details of eligibility and how to obtain this are on the website.

NHS Evidence
The creation of NHS Evidence was announced as part of the High Quality care for All report from Lord Darzi. The key aim of the NHS Evidence services is 'to provide easy access to a comprehensive evidence base for everyone in health and social care who takes decisions about treatments or the use of resources - including clinicians, public health professionals, commissioners and service managers - thus improving health and patient care.'  A web-based portal enables searching across many sources of clinical, non-clinical and social care information. This includes specialist topic-based resources.

NHS Education for Scotland: Knowledge Network
The Knowledge Service supports evidence-based practice, communication and collaboration by communities, and access to e-Learning. All NHS staff and students working for NHS Scotland are able to access the full range of resources provided by the Knowledge Service via an Athens password. The service provides databases and full text journals and also a series of specialist portals. Some of this information is freely accessible.

NHS Wales eLibrary for health
The NHS Wales eLibrary allows access to a range of resources including databases, evidence based resources, guidelines, ejournals and ebooks. There is also a directory of local libraries. Authorised NHS Wales users will need to register for an Athens password in order to use these. Details of how to register for this are on the website.

NICE: Clinical Knowledge Summaries
This service has been launched by the National Institute for Health and Care Excellence and provides primary care practitioners with a readily accessible summary of the current evidence base and practical guidance on best practice in respect of over 300 common and/or significant primary care presentations. The CKS service will provide regular updates to all topics and up to 10 new primary care topics each year. CKS content is also searchable through NICE Evidence Search where a wide range of additional information resources may be found.

Patient safety

See also the RCN's resource on Patient safety and human factors.

1000 Lives Plus
1000 Lives Plus is a national improvement programme, supporting organisations and individuals, to deliver the highest quality and safest healthcare for the people of Wales.It achieves this through a number of initiatives including a series of improvement programmes and publications based on learning from these,  leadership via a 1000 Lives Plus Faculty, and engagement via events and communications forum and study days.

HSC Safety Forum
The forum was launched in 2007 to 'to promote a safety culture within health and social care organisations and share best practice, supporting organisations in implementing evidence-based interventions proven to reduce harm and save lives and measuring patient safety improvement'. The forum has a role in facilitating education and training, promoting collaboration and patient/client participation in safety work. In October 2008 the forum merged with the Clinical and Social Care Governance Support Team.

National Patient Safety Agency (NPSA) Patient safety website
On 1 June 2012 the key functions and expertise for patient safety developed by the NPSA transferred to NHS England.

The operational delivery of the National Reporting and Learning System (NRLS) has been transferred from the NPSA to Imperial College Healthcare NHS Trust (ICHT), with the NHS CBA retaining an oversight role. Health care organisations should continue to report patient safety incidents to the NRLS – see Report a patient safety incident.

Scottish Patient Safety Programme
The Scottish Patient Safety Programme aims to improve the safety of hospital care across Scotland using evidence-based tools and techniques to improve the reliability and safety of everyday health care systems and processes. The Programme is co-ordinated by Healthcare Improvement Scotland.

Quality improvement communities

CHAIN (Contact, Help, Advice and Information Network)
CHAIN is a well-established networking tool and has a community of almost 12,000 people who are willing to share their experience and ideas with one another. These include frontline healthcare practitioners from all professions, managers, educators, researchers and knowledge specialists. Membership is free and benefits include: access to a searchable online directory of health and social care professionals, detailing their interests, experience and aspirations and the ability to pose questions, seek advice or find collaborators from a diverse pool of members. 
CHAIN also has a number of Sub-groups and Special Interest Groups. These include groups focussing on: Quality improvement; Improving patients’ experience; Patient and public involvement; Safer Patients Network.

NHS Improving Quality (NHS IQ)
NHS IQ is part of NHS England and “is creating for the first time an improvement organisation that is in alignment with the needs and challenges of the NHS”. It draws together the experience of previous successful improvement programmes: National Cancer Action Team; National End of Life Care Programme; NHS Diabetes and Kidney Care; NHS Improvement. For details of how NHS IQ will provide improvement and change expertise to support the health outcomes for people across the NHS in England see: NHS Improving Quality: Our strategic intent (PDF 872KB).

NHS Improvement
NHS Improvement is now closed. The national body for improvement is now NHS Improving Quality (NHS IQ) which is drawing on the successful improvement work of this and other bodies.

NHS Institute for Innovation and Improvement (NHS Institute)
NHS Institute for Innovation and Improvement is now closed. The national body for improvement is now NHS Improving Quality (NHS IQ) which is drawing on the successful improvement work of this and other bodies.

NHS Networks
NHS Networks was formed in 2005 to promote the development of networking in the health service and support the role of networks in promoting learning and change. The website provides a home for many  networks - “a common space in which leaders, clinicians, managers and support staff and their partners beyond the NHS can explore ideas, pool experience, solve problems and share information”. It is possible to search across all networks on the site using the network finder. The site also  includes a blog, a message board and news.

NHS Scotland: National Managed Clinical Networks
Managed Clinical Networks are virtual entities designed to drive upwards the standards of patient care through integration of services and collaboration. The networks can work across health board and trust boundaries and may also involve practitioners and organisations from other fields of practice, for example social workers and charities. This website lists the Managed Clinical Networks across Scotland and links to their websites.

Regulatory and review bodies

Care Quality Commission (CQC) (England)
The Care Quality Commission (CQC) is the health and social care regulator for England which was established by the Health and Social Care Act 2008 and came into operation in April 2009. The aim of the CQC is "to make sure better care is provided for everyone in hospital, in a care home and at home". The commission brings together independent regulation of health, mental health and adult social care.  The CQC’s activities encompass the registration and licensing of health and social care providers, and monitoring and inspection of all health and adult social care provided either by the NHS or independently. All health and adult care services are registered and monitored against the Essential standards of quality and safety. 

The RCN Policy Unit has produced a briefing on the CQC and a briefing which summarises key lessons from published reports on health and social care system regulation, at the point at which the CQC begins its work, and the RCN view on system regulation:

See Policy briefing 15/2008 - The Care Quality Commission (CQC) in England (PDF 67.8KB) [See: How to access PDF files]
See Policy briefing 05/2009: Looking back to look forward: key lessons from system regulation of health and social care in England (PDF 48KB).

Care Inspectorate (Scotland)
The Care Inspectorate came into operation on 1 April 2011 as a new unified independent scrutiny and improvement body for care and children’s services and was initially known as Social Care and Social Work Improvement Scotland (SCSWIS).  It is responsible for regulating and inspecting care services, and carrying out social work and child protection inspections. The services regulated are provided by a range of organisations – local authorities, individuals, businesses, charities and voluntary organisations.  Through this work the care Inspectorate also has a significant part to play in improving services for adults and children across Scotland.

Care and Social Services Inspectorate Wales (CSSIW) (Wales)
The CCSIW registers and regulates social care in Wales including working with other regulators and inspectorates in Wales and across the UK. This includes early years care. In April 2009 a new overarching framework for local authority social services inspection, review and evaluation was introduced which aims to be citizen focussed and encourage improvement, innovation and ownership of change by local government. Care services are regulated using the regulations and national minimum standards set by the Welsh Assembly Government.

Healthcare Improvement Scotland (Scotland)
Healthcare Improvement Scotland came into operation on 1 April 2011 and “has the focus and key responsibility to help NHS Scotland and independent health care providers deliver high quality, evidence-based, safe, effective and person-centred care; and to scrutinise services to provide public assurance about the quality and safety of that care”. It builds on work previously done by NHS Quality Improvement Scotland (NHS QIS) and the Care Commission and includes a number of organisations such as the Scottish health Council; the Scottish Intercollegiate Guidelines Network (Sign) and the Healthcare Environment Inspectorate and a number of others.  Healthcare Improvement Scotland’s work in supporting the quality strategy encompasses three main areas – evidence, improvement and scrutiny. The work programme activities are described as: advice, guidance and standards; improvement and implementation support; assurance, scrutiny, measurement and reporting.

Healthcare Inspectorate Wales (HIW) (Wales)
The Healthcare Inspectorate Wales (HIW) is the independent inspectorate and regulator of all healthcare in Wales. HIW’s core role is to review and inspect NHS and independent organisations in Wales to ensure that services are safe and of good quality. Services are reviewed against a range of published standards, policies, guidance and regulations.

Regulation and Quality Improvement Authority (Northern Ireland)
The Regulation and Quality Improvement Authority (RQIA) has an overall responsibility for monitoring and inspecting the availability and quality of health and social care services in Northern Ireland, and encouraging improvements in the quality of those services. This includes the regulation of independent hospitals and clinics and nursing agencies.  RQIA inspects a wide range of health and social care services against a set of minimum standards and the quality standards for health and social care. With the transfer of duties of the Mental Health Commission to RQIA the Authority also undertakes a range of responsibilities for people with a mental illness and those with a learning disability.


Health Foundation
The Health Foundation is an independent charity working to continuously improve the quality of healthcare in the UK. The Foundation aims “to develop the technical skills, leadership, capacity, knowledge, and the will for change, that are essential for real and lasting improvement”. 

Health Services Management Centre (HSMC) at the University of Birmingham
The centre is one of the leading centres specialising in policy, development, education and research in health and social care services in the UK. Its key purpose is to 'strengthen the management and leadership of these services and to promote improved health and wellbeing'.

Quest for Quality Improvement and Performance (QQUIP)
QQUIP was a five-year research programme funded by the Health Foundation from 2005–2010, providing a source of independent commentary and data about the quality and performance of healthcare provision. Research reports produced by QQUIP can be downloaded from the website.